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Exam 1 Knowledge Checks (Newborn)

Terms in this set (84)

How do hypoxia during birth, a cool delivery room, and handling at birth stimulate the newborn to breathe?
Hypoxia causes decreased PO2 and pH and increased PCO2. These, along with cool air and handling at birth, affect chemoreceptors and sensors that stimulate the respiratory center to cause initiation of respirations at birth.
Why is surfactant important to the newborn's ability to breathe easily?
Surfactant reduces surface tension in the alveoli and allows them to remain partially open on expiration, reducing the work of breathing.
How is fetal lung fluid removed before and after birth?
Fetal lung fluid begins to move into the interstitial spaces shortly before birth and when air enters the lungs at birth. It is absorbed from the interstitial spaces by the lymphatic and vascular systems. A small part of the fluid is squeezed out during birth.
What causes the closure of the ductus arteriosus, foramen ovale, and ductus venosus at birth?
The ductus arteriosus closes as a result of increases in blood oxygen and decreased prostaglandins from the placenta. The foramen ovale closes when pressure in the left atrium exceeds that in the right atrium. The ductus venosus closes when the vessels of the cord become occluded.
What causes the pulmonary blood vessels to dilate and the ductus arteriosus to constrict?
At birth, increasing oxygen causes the pulmonary blood vessels to dilate. In addition, movement of fetal lung fluid into the interstitial tissues allows more room for expansion of the pulmonary vessels. The ductus arteriosus constricts because of the increased oxygen in the blood when the neonate begins to breathe.
Why are neonates more prone to heat loss than older children or adults?
Newborns have thinner skin with less subcutaneous fat than older children and adults. They have blood vessels close to the surface and a larger skin surface area. These all contribute to greater loss of heat than in older children or adults.
What are the effects of low temperature in newborns?
Newborns respond to low temperatures by increasing activity, flexion, and metabolism; vasoconstriction; and nonshivering thermogenesis. This raises oxygen and glucose consumption and may cause respiratory distress, hypoglycemia, acidosis, and jaundice.
Why do newborns have higher levels of erythrocytes, hemoglobin, and hematocrit than adults?
Newborns have higher levels of erythrocytes and hemoglobin than adults because the available oxygen is lower before birth than after birth. More red blood cells with fetal hemoglobin are needed to adequately oxygenate the cells in the fetus.
How do the stools change over the first few days after birth?
Stools progress from thick, greenish-black meconium to loose, greenish-brown transitional stools to milk stools that are frequent, soft, seedy, and mustard-colored if the infant is breastfed, and pale yellow or light brown, firmer, and less frequent if formula fed.
Why is hypoglycemia a problem for the newborn?
Hypoglycemia is a problem for the newborn because glucose is the major source of energy in the brain.
Why are infants more likely than adults to become jaundiced?
Infants have an immature liver and more hemolysis of erythrocytes than adults. Trauma at birth, poor early feeding, and an intestinal enzyme that deconjugates bilirubin also increase jaundice.
What are the differences among physiologic, nonphysiologic, and breast milk jaundice?
Physiologic jaundice occurs in normal newborns after the first 24 hours of life as a result of hemolysis of unneeded red blood cells and immaturity of the liver. Nonphysiologic jaundice is generally a result of excessive destruction of erythrocytes, causing bilirubin levels to rise faster and higher than in physiologic jaundice. It begins within the first 24 hours and may necessitate phototherapy. True breast milk jaundice lasts longer than physiologic jaundice and may result from substances in the milk.
How does the distribution of fluid in the newborn compare with that in the adult?
The newborn's body is composed of a greater percentage of water with more located in the extracellular compartment than in the adult's body.
Why are IgG, IgM, and IgA important to the newborn?
Newborns receive passive immunity to infections when IgG crosses the placenta in utero. After birth, infants produce IgM and IgA to protect against infection. IgM rises in response to infection. IgA helps protect the gastrointestinal and respiratory tracts from infection and is present in breast milk.
Describe the behaviors of newborns during the first and second periods of reactivity.
During both periods of reactivity, newborns are active and alert, may be interested in feeding, may have elevated pulse and respiratory rates, and may have transient signs of respiratory distress.
How do infant behavioral states vary?
In the deep or quiet sleep state, the infant is in a deep sleep with regular respirations and little response to outside stimuli. In active sleep, infants move about and may have irregular respirations. The drowsy state is the time between sleep and waking. In the quiet alert state, the infant is awake and interested in stimuli. The active alert state is a fussy period that may lead to the crying state if the infant's needs are not met.
What is the purpose of the early focused assessments of the infant after birth?
Focused assessments of the infant immediately after birth help detect serious abnormalities that need immediate attention. They focus on cardiorespiratory status, thermoregulation, and the presence of anomalies. A more complete assessment follows when the infant is stable.
What is included in assessment of the newborn's cardiovascular status?
The cardiovascular assessment includes evaluation of history, airway, color, heart sounds, and pulses. Blood pressure is assessed if indicated.
Why is taking a rectal temperature dangerous in an infant?
Taking a rectal temperature is dangerous because it risks perforation of the rectum, which turns sharply to the right after about 3 cm (1.2 inches).
What are the differences among molding, caput succedaneum, and cephalohematoma?
Molding of the head is a change in the shape because of normal temporary overriding of bones during birth. Caput succedaneum is localized swelling from pressure against the cervix, which can cross the suture lines. Cephalhematoma is bleeding between the periosteum and the bone that never crosses suture lines. Molding and caput disappear within a few days, but cephalhematoma may last for 2 to 3 months.
Why are measurements of the neonate important?
Measurements of the infant help determine if in utero growth was adequate for gestational age and if complications are present.
What are some signs of hypoglycemia?
Some signs of hypoglycemia are jitteriness, poor muscle tone, respiratory distress (tachypnea, dyspnea, apnea, and cyanosis), high-pitched cry, diaphoresis, low temperature, poor suck, lethargy, irritability, seizures, and coma.
Why is it important to use the correct site for heel punctures when obtaining blood samples?
Using an incorrect site for heel punctures risks injury to the bone, nerves, or blood vessels of the heel.
Why is assessment of newborn reflexes important?
Newborn reflexes provide information about the status of the neonate's central nervous system.
Why is it important for the nurse to observe the first feeding carefully?
The first feeding allows the nurse to evaluate the newborn's ability to suck, swallow, and breathe in coordination and assess for signs of esophageal atresia or tracheoesophageal fistula.
When should the first voiding occur? How often do infants void?
Infants should void within 12 to 48 hours. Infants void at least one to two times during the first 2 days and at least 6 times a day by the fourth day.
What is the nurse's responsibility regarding marks on the newborn's skin?
The nurse documents location, size, color, elevation, and texture of marks on the skin; explains marks to parents; and offers emotional support as needed.
Why is the gestational age assessment important?
The gestational age assessment provides an estimate of the infant's age since conception and alerts the nurse to possible complications related to age and development.
How do the periods of reactivity affect nursing care?
The periods of reactivity are important because the infant may need nursing intervention for low temperature, elevated pulse and respirations, and excessive respiratory secretions. During the sleep period, the infant will have relaxed muscle tone and no interest in feeding.
Why are prophylactic medications given to all newborns?
Newborns receive vitamin K to prevent vitamin K-dependent bleeding. The eyes are treated with an antibiotic ointment to prevent ophthalmia neonatorum.
How can nurses prevent heat loss in newborns?
Nurses can prevent heat loss in newborns by keeping them dry, covered, and away from cold objects or surfaces, drafts, and outside windows and walls and by teaching parents.
What should the nurse do when an infant shows signs of hypoglycemia?
When infants show signs of hypoglycemia, the nurse should follow agency policy to check the blood glucose level and temperature, feed the infant, and watch for signs of other complications.
What are some interventions for preventing jaundice in newborns?
Interventions for preventing jaundice include ensuring the infant is feeding well by working with mothers and infants having difficulty and teaching parents about jaundice and what observations they should make.
How can the nurse prevent a baby being given to the wrong parent?
Nurses can prevent a baby being given to the wrong parents by always checking the infant's identification and parent's identification every time the two are reunited.
What can nurses and parents do to prevent infant abductions?
Nurses and parents can prevent infant abductions by always being alert for suspicious behavior and stopping anyone who might be taking a baby. Nurses must teach parents how to identify hospital staff and that they should never allow anyone without proper identification to remove their infant from them.
What is the most important method of preventing infection in newborns?
Scrupulous handwashing by staff and all who come in contact with newborns is the most important way to prevent infections in newborns.
What are the reasons parents decide for or against circumcision?
Parents choose circumcision because of the decreased incidence of urinary tract infections, penile cancer, and some sexually transmittable diseases; religious dictates; parental preference; and lack of knowledge about care of the foreskin. Parents decide against circumcision because it causes pain and the risk of hemorrhage, infection, poor cosmetic result, stenosis or fistulas of the urethra, adhesions, necrosis, or other injury to the glans penis. They also question the need for surgery to prevent uncommon conditions.
What information do parents need about care of the intact and circumcised penis?
Teach parents not to retract the foreskin on an uncircumcised penis until it begins to separate from the glans later in childhood. They can teach the child to retract it to clean after separation occurs. Teach parents of circumcised infants to watch for bleeding and infection and to apply petroleum jelly as instructed unless a Plastibell was used.
What are some important considerations in planning parent teaching?
Planning parent teaching includes coordinating teaching to include all topics, setting priorities based on parents' needs, using a variety of teaching techniques, modeling behavior, including other family members, and considering culture and language.
What immunization may be performed at the birth facility?
The first hepatitis B vaccine is given at the birth facility to infants of uninfected mothers, as well as to those whose mothers are positive for hepatitis B. Hepatitis B immune globulin is also given to infants of infected mothers.
Why is it important to perform screening tests on infants' blood as close to discharge as possible? For which infants is retesting important?
Newborn screening tests should be performed as close to discharge as possible, as the blood tests are more sensitive after the first 24 hours of life. If infants are discharged earlier, they should be retested so that any disorders can be diagnosed early.
Where do parents obtain information about caring for their infant during the early weeks after birth?
Parents obtain information about infant care from friends, family, nurses, health care providers, child care classes, television, books, magazines, and the Internet.
What are some ways in which nurses offer follow-up services to new parents?
Nurses may provide follow-up phone calls, home visits, clinic visits, and child care classes.
What advice can the nurse offer to parents about the safety features of equipment used for infants?
All equipment should be checked for safety, and parts should be inspected to ensure that they are functioning properly.
What should the nurse teach parents about buying and using a car seat?
Car seats must be chosen according to the size of the infant and must be used correctly to maintain safety. Newborns should be placed in rear-facing car seats in the back seat of the car.
Why should parents respond to crying without fear of spoiling the infant?
Infants are not "spoiled" by prompt attention to their needs. Prompt, consistent response to crying may decrease overall crying later.
How can nurses help parents of crying infants?
Nurses can assist parents of crying infants to determine the cause and teach them appropriate techniques for coping with a crying infant. Therapeutic communication techniques can be used to help parents with negative feelings.
How can parents prevent or treat diaper rash?
Diaper rash can be prevented by keeping the area clean and dry and avoiding products to which the infant seems sensitive. If rash occurs, parents should expose the area to air and apply creams sparingly.
When should infants begin solid foods?
Infants should not start solid foods until 6 months old.
How can a parent differentiate between regurgitation and vomiting?
Regurgitation is expulsion of small amounts of milk, often along with a burp. Vomiting involves larger amounts that are expelled with more force.
How can parents use their knowledge about infant development to prevent accidents in the first 12 weeks of life?
Understanding the infant's changing capabilities helps parents assess situations and the home environment to prevent accidents.
What is the purpose of well-baby checkups?
Well-baby checkups allow the health care provider to assess the infant's growth and development, provide parent teaching, and give immunizations.
Why are immunizations important?
Immunizations prevent infants from becoming infected with very serious communicable diseases.
When should immediate help be sought for an infant?
Immediate help should be obtained if infants have difficulty breathing, are cyanotic, or are hard to arouse from sleep.
What should nurses teach parents about SIDS?
The cause of sudden infant death syndrome (SIDS) remains unknown, but the risk may be increased with sleeping in a prone position or on soft, loose bedding, overheating, maternal smoking, and sleeping with another person or on an adult bed or sofa. Infants should sleep alone in a supine position at all times.
How does the appearance of a preterm infant differ from that of a full-term infant?
Preterm infants appear frail and weak and are small, with limp extremities; poor muscle tone; red skin; and immature ears, nipples, areolae, and genitals.
What factors contribute to respiratory problems in preterm infants?
Factors that increase respiratory problems in preterm infants include lack of surfactant, poor cough reflex, small air passages, and weak muscles.
What nursing responsibilities relate to care of preterm respiratory problems?
Nursing responsibilities include working with respiratory therapists to manage equipment, monitoring the infant's changing oxygen needs, positioning infants to promote drainage, and suctioning.
How do nurses help infants adjust to the cooler environment of an open crib?
Nurses wean infants to the open crib by making gradual changes in the environmental temperature, dressing the infant, and using blankets and a hat when the infant is out of the incubator.
How does the nurse keep track of an infant's intake and output?
To measure intake and output for infants, all fluids (IV and oral), including medications, are measured. Diapers are weighed to calculate urine output, and drainage, regurgitation, and stools are measured.
What special problems related to fluid balance, infections, and pain occur in preterm infants?
Preterm infants' kidneys do not concentrate or dilute urine well, and they have large insensible water losses. They lack passive antibodies from the mother and have an immature immune system. Pain causes physiologic and behavioral responses and can have long-term effects.
What nonpharmacologic measures can nurses use to manage pain in infants?
Nonpharmacologic methods to manage pain in infants include positioning, swaddling, facilitated tucking, sucking, sucrose, skin-to-skin positioning, and breastfeeding.
What can the nurse do for the infant at risk for stress from overstimulation?
The nurse can diminish overstimulation by organizing care to provide for rest periods, reducing environmental stimuli, minimizing pain, and discussing the plan of care with others.
How does the nurse assess feeding tolerance?
Feeding tolerance is assessed by checking gastric residual volume before gavage feedings, measuring abdominal girth, testing stools for reducing substances and blood, and observing for regurgitation. During nipple feedings, the nurse watches for signs of respiratory difficulty, decreased oxygenation, and fatigue.
Why should the nurse allow the infant to set the pace of feedings instead of urging continuous sucking?
When allowed to set the pace of feedings, infants can stop to rest to conserve energy, regulate breathing, and control the flow of milk. Moving the nipple in the infant's mouth may cause fatigue and choking.
How can the nurse help the mother who wants to breastfeed her preterm infant?
The nurse can help breastfeeding mothers of preterm infants by helping them pump and store milk, by teaching breastfeeding techniques adapted to the preterm infant's needs, and by providing support and encouragement.
How can the nurse help parents be comfortable with their preterm infant?
The nurse can help parents feel comfortable with preterm infants by providing warm support, realistic encouragement, and information about the neonatal intensive care unit (NICU) environment, the infant's condition and characteristics, and the equipment and care. Involving the parents in care also helps.
How should the nurse prepare parents for the discharge of their preterm infant?
Beginning early in hospitalization, the nurse should help parents take on gradually increasing responsibility for care of the infant, which will help them prepare for discharge. Helping them prepare their home for the infant is also important.
What is the typical appearance of the infant with postmaturity syndrome?
Postmature infants may be thin and may have loose skin folds, cracked and peeling skin, minimal vernix, long nails, and meconium staining.
What special problems might a postmature infant have?
Postmature infants may have polycythemia, meconium aspiration, hypoglycemia, and poor temperature regulation.
How are symmetric and asymmetric FGR different?
In symmetric growth restriction, all body parts are proportionately small. In asymmetric growth restriction, the head is normal in size but seems large for the body, the weight is decreased, and the length is generally normal.
What problems may occur in infants who are LGA?
Large-for-gestational-age (LGA) infants may have birth injuries such as fractures, nerve injury, cephalhematoma, hypoglycemia, and polycythemia.
What is the most important element in resuscitation?
Effective ventilation is the most important element in resuscitation. Chest compressions and medications are rarely needed. Although most newborns have no difficulty with breathing at birth, up to 10% require some help to begin respirations and 1% require extensive resuscitative measures.
What is the role of the nurse in care of the infant with asphyxia?
The nurse's role in the care of the infant with asphyxia is to begin resuscitation promptly, assist the team, and provide follow-up and parental support.
How is TTN different from RDS?
Transient tachypnea of the newborn is caused by failure of fetal lung fluid to be absorbed completely in infants who are usually full-term or late preterm. Respiratory distress syndrome occurs in preterm infants as a result of inadequate surfactant.
Which infants are most likely to have meconium staining of the amniotic fluid?
Meconium staining is most likely to occur when infants are postterm, small for gestational age (SGA), have decreased amniotic fluid, and have cord compression.
Why is there resistance of blood flow into the lungs in PPHN?
Infants with persistent pulmonary hypertension of the newborn (PPHN) have constriction of the pulmonary blood vessels from inadequate oxygen levels. This increases resistance to blood flow from the heart into the lungs and causes blood to flow through the foramen ovale and patent ductus arteriosus.
How can kernicterus be prevented?
Kernicterus can be prevented by identifying women whose infants are at risk for blood incompatibilities, giving Rh-negative mothers Rh immune globulin, recognizing infants with bilirubin levels that are not normal, and instituting phototherapy when it is needed.
How can the nurse help reduce bilirubin levels in infants receiving phototherapy?
Nurses can help reduce bilirubin in an infant receiving phototherapy by ensuring that the lights or blankets are functioning and positioned properly; reducing the infant's time out of phototherapy; ensuring adequate milk intake to increase removal of bilirubin by frequent stools; preventing cold stress or hypoglycemia, which would decrease albumin-binding sites for bilirubin; and turning the infant frequently to expose all areas to the lights.
What is the role of the nurse in caring for the infant with sepsis?
The role of the nurse in sepsis is to use infection prevention methods, identify infants at risk, watch for early signs, notify the physician, coordinate treatment, observe for change, and support the family.
Why are IDMs more likely to develop macrosomia?
Macrosomia occurs in infants of diabetic mothers (IDMs) because of excessive transfer of glucose, amino acids, and fatty acids from the mother to the fetus. This results in fetal production of insulin and excessive growth in the fetus.
Why are IDMs at risk for hypoglycemia after birth?
Infants of diabetic mothers (IDMs) may develop hypoglycemia after birth because they have high levels of insulin even though they no longer receive glucose from the mother. Infants may need early feeding as a result.
How can the nurse deal with the inability to rest in infants with prenatal exposure to drugs?
The nurse can help the drug-exposed infant rest by minimizing stimulation, swaddling in a flexed position, organizing care to avoid interruptions, and providing a pacifier.
How can the nurse promote bonding when there has been prenatal drug abuse?
The nurse can promote bonding in cases of prenatal drug abuse by helping the mother feel welcome, encouraging her to participate in infant care, teaching her how to respond to the infant's behavior and about the infant's care, and modeling parenting behaviors.
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